Could I end up with a decent head of hair without using finasteride? I'm willing to get hairline lowering & regular transplants.

You have to accept the cards that you were dealt. It has nothing to do with Propecia or Surgery.You don't need to take Propecia but it can help with your crown area.  You can have surgery to add hair to the front hair line or the crown area.  (without Propecia)The real issue is that if you were born with the genes for male pattern balding, there is nothing you can do to STOP it.  Propecia and hair transplant just help.

Any male under 30 needs to be cautious about hair transplant surgery - but men under 25 need to extremely cautious.  Hairline lowering is rarely a good idea. If a patient is experiencing a Norwood 2 pattern of hair loss at 23, he needs to prepare for the possibility of significant balding AND the possibility of "running out" of grafts to transplant.  This may or may not occur but one needs to be prepared. A thick hairline could be done down the road once your doctor gets a better sense of if and how you will bald. For now, most surgeons would advise against any lowering of a hairlineIn the worse case scenario, a male with Norwood 2 pattern of hair loss could have no donor hairs for transplanting (if they show a pattern called diffuse pattern alopecia in their 20s) or under 3000.  Where to put these grafts one's life is so important. It's difficult (if not impossible) to accurately predict this at 23

At 23, you should be very careful about undergoing a transplant. You have to take into consideration what appears "normal" at this age, vs. "normal" in 20, 30 or 40 years.  Transplanted hairs are likely to be permanent and the biggest mistake young men make is trying to attain a hairline that is too low.  With time it could look unnatural which is exactly the opposite affect you are desiring.  It can also create the situation of constantly having to "chase" the original work, i.e. trying to maintain a low hairline while the hairloss progresses behind it over time.  Finasteride is our best defense for male pattern hairloss both in the front and back of the scalp and I recommend it to most all young men who are worried about hair loss. However, even with medication, progression will continue and it is impossible to know what your donor hair will be like in 20 years.  There is not an endless supply of donor hair so it's best to plan wisely and proceed with transplant when both your pattern of hairloss and donor hair is a more well established.

You can do hair transplant to lower your hairline and make it look thick and natural.  The use of Ultra refined technique allows for dense packing in the frontal hair line which gives a very natural and full appearance.  Propecia is usually more effective in the crown area and we usually do not recommend it for clients with frontal hair loss.  You can do the hair transplant to lower your hair line and stop using propecia.  Keep in mind that if you have male pattern hair loss, your hair loss is progressive and you may need additional transplant in the future.

From the question you posed, it seems as if some doctor recommended Propecia for what sounds like genetic balding that participated in your large forehead. A hairline lowering procedure in a young male with active genetic recession of the hairline is asking for trouble. Without the drug finasteride (Propecia), the balding process is highly likely to continue and get worse.  I would recommend that you follow your doctors advice and go on Propecia for a year to see if the balding will reverse.